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Archived: Clinton House Nursing Home Inadequate

Reports


Inspection carried out on 1 November 2016

During a routine inspection

Clinton House is a care home which offers care and support for up to 46 predominantly older people. At the time of the inspection there were 28 people living at the service. Some of these people were living with dementia. The building is a detached house over two floors with a recently added extension on the ground floor comprising of five new en suite rooms. Clinton House is part of the Morleigh Group of care homes.

The service is required to have a registered manager and there was one in place. However, the registered manager had been on maternity leave since August 2016. A temporary manager had covered the role for the first six weeks and another manager had been appointed nine days before our inspection. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

We carried out this unannounced comprehensive inspection of Clinton House Nursing Home on 1 November 2016. We brought forward the planned comprehensive inspection due to concerns that had been raised with us. These concerns related to the premises and equipment, the quality of the food, lack of activities, poor care practices, staff working without the relevant recruitment checks, staff training and medicines. At this inspection we also checked to see if the service had made the required improvements identified at the inspection of 7 April 2016.

In April 2016 we found the premises and equipment were not properly maintained. We found there was hot water at 50 degrees centigrade coming from two taps in bathrooms used by people who lived at the service. At a previous inspection in February 2016 we had also found water that was too hot coming from a different tap used by people living at the service. At this inspection we found another two taps with water coming from them that was too hot. This posed an on-going risk of people scalding themselves that had not been adequately addressed by the provider, despite being asked to rectify these issues at two previous inspections.

We also found at this inspection that there was no hot water coming from sinks in the laundry room for staff to wash their hands. There were several toilets and bathrooms, used by people living at the service, with no soap or paper towels. This meant people, visitors and staff were unable to wash their hands effectively after using the toilet.

At the inspections in April 2016 we had concerns about poor recording and missing records, of the information given to staff when they started a shift. We had raised the same concerns at previous inspections in February 2016 and October 2015. This meant it was difficult to establish what information had been provided for staff at each shift change to ensure they had the right information to meet people’s needs. At this inspection we were able to see records of daily handover meetings. The information in these records was basic, although staff told us they were given detailed verbal handovers. However, on the day of the inspection an agency worker asked repeatedly during the morning if they could have a handover as they did not know what peoples’ needs were. This meant the system for providing staff with information about people’s needs at each shift was still not robust.

The care we saw provided to people during the inspection was often task orientated rather than in response to each person’s individual needs. Care plans did not always give staff guidance about how to provide the appropriate care to meet people’s needs. People were not always referred to appropriate healthcare professionals in a timely manner. This mean relevant treatment to help people was delayed. The high reliance of the service on bank and agency workers meant that people did not always receive care from staff who knew and understo

Inspection carried out on 7 April 2016

During an inspection to make sure that the improvements required had been made

We carried out a focused unannounced inspection at Clinton House on the 2 February 2016. At that inspection we identified breaches of the legal requirements. We issued three warning notices and two requirements and told the provider to take action to address the breaches of the regulations. Following the February 2016 inspection the provider sent the Care Quality Commission an action plan outlining how they would address the identified breaches.

Prior to this inspection the Care Quality Commission received information of concern relating to people not always having their care needs met. Concerns had also been raised about staffing levels and some aspects of the premises at Clinton House. We carried out this focused inspection to check on the actions taken by the service to meet the requirements of the regulations and to follow up on the information of concern received.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Clinton House on our website at www.cqc.org.uk

Clinton House is a care home which offers care and support for up to 46 predominantly older people. At the time of the inspection there were 30 people living at the service. Some of these people were living with dementia. The building is a detached house over two floors with a recently added extension on the ground floor comprising of five new en suite rooms. Clinton House is part of the Morleigh Group of homes.

A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager for Clinton House was working at a different service in the Morleigh Group. The manager working at Clinton House at the time of this inspection was the registered manager from another service in the group. This manager was in the process of applying to be the registered manager for Clinton House.

At the February 2016 inspection we found prescribed creams were not always dated when started and not always stored safely. A recent external pharmacy audit highlighted concerns which remained since the last audit which produced actions that needed to be taken a year before. Medicines for disposal were not stored in accordance with the advice given in January 2016. Out of date blood bottles and needles had not been disposed of. The medicine policy used at the service needed to be reviewed.

At this inspection the manager was unaware of any outstanding actions relating to the external pharmacy audit. The pharmacist told us they were unaware of any actions that had been taken by the service since the last Medicine Advice Visit in January 2016. We found prescribed creams were mostly dated upon opening and were stored safely. All items stored in the medicines room were regularly checked to help ensure any item which was out of date was removed. The medicine policy had been fully reviewed since the last inspection.

At the February 2016 inspection we found hot water recorded at 50 degrees centigrade coming from a tap in a toilet used by people who lived at the service. Hot water at this temperature risks scalding people. There were incontinence odours at the service. Equipment had been left in corridors which posed a risk to people using the corridors. Inspection of the premises and equipment used at the service was not reviewed effectively in order to identify any defects or faults.

At this inspection we again found there was hot water recorded at 50 degrees centigrade coming from two taps on the first floor, which were used by people who lived at the service. This continued to pose a scald risk to people using the hot water. Checks were regularly carried out on pressure relieving mattresses.

Inspection carried out on 2 February 2016

During an inspection to make sure that the improvements required had been made

This unannounced focused inspection took place on 2 February 2016. The last inspection took place on 20 October 2015, and at that inspection the service was not meeting the requirements of the regulations. We issued requirements and a warning notice and told the provider to take action to address the breaches of the regulations. Following the inspection in October 2015 the provider sent the Care Quality Commission an action plan outlining how they would address the identified breaches. We carried out this inspection to check on the actions taken by the service to meet the requirements of the regulations.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Clinton House on our website at www.cqc.org.uk

Clinton House is a care home which offers care and support for up to 46 predominantly older people. At the time of the inspection there were 30 people living at the service. Some of these people were living with dementia. The building is a detached house over two floors with a

recently added extension on the ground floor comprising of five new en suite rooms.

A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008.

and associated Regulations about how the service is run. The service did not have a registered manager in post. The manager who was previously applying to be the registered manager at our last inspection had been moved to another service in the group. However, there was a new manager in post at this inspection, who had now applied to become the registered manager. The new manager present at this inspection had been in post since November 2015.

At the last inspection we found medicines storage, recording and administration was not entirely safe. Care plans did not always provide staff with clear guidance on how to respond to risks and help reduce them. Accidents and incidents that took place in the service were not always recorded by staff in people’s records. The safeguarding adults policy did not contain the contact details of the local authority or the Care Quality Commission to assist people in raising any concerns they may have.

At this inspection we found some improvements had been made to the recording and administration of medicines. There were no gaps in the Medicine Administration Records (MAR) or handwritten entries of the MAR. Medicines that required stricter controls were recorded accurately and the records balanced with the stocks held. The cold storage of medicines was being monitored daily and was within safe limits. However, creams were not always recorded when started and not always stored safely. A recent external pharmacy audit highlighted concerns which remained since the last audit which produced actions that needed to be taken a year before. Medicines for disposal were not stored in accordance with advice given in January 2016. Out of date blood bottles and needles were found.

Accidents and incidents were recorded by staff in people’s records and these incidents were audited by the new manager. Care plans showed that where a risk had been identified there was guidance for staff on how to support people appropriately in order to minimize risk and keep people safe. The safeguarding adults policy had been reviewed and updated appropriately. However, we found hot water recorded at 50 degrees centigrade coming from a tap in a toilet used by people who lived at the service. Hot water at this temperature risks scalding people.

At the last inspection we found incontinence odours were present at the service. People’s care records were not stored securely. Equipment was found lying in corridors such as TV’s, parts of a bed rail, a mattress pump unnamed continenc

Inspection carried out on 20 October 2015

During a routine inspection

This inspection took place on 20 October 2015 and was an unannounced comprehensive inspection. This scheduled inspection was brought forward in response to anonymous information of concern received.

The last inspection took place on 10 June 2015. The service was meeting the requirements of the regulations at that time, however the overall rating of Requires Improvement from the inspection in December 2014 was not changed as the service needed to demonstrate they were able to maintain the improvements made.

Clinton House is a care home which offers care and support for up to 46 predominantly older people. At the time of the inspection there were 38 people living at the service. Some of these people were living with dementia. The building is a detached house over two floors with a recently added extension on the ground floor comprising of five new ensuite rooms.

A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The service did not have a registered manager in post. However, there was a manager in post who had applied to become the registered manager.

We looked at how medicines were managed and administered. We found it was not always possible to establish if people had received their medicines as prescribed. There were gaps in the Medicine Administration Records (MAR) where staff had not always signed to show people had received their prescribed medicines. Handwritten entries made by staff on to the MAR following advice from medical professionals, were not always signed and witnessed. Creams were not dated upon opening. The refrigerator used for the cold storage of medicines was not regularly monitored and was not consistently storing medicines between 2 and 8 degree centigrade. Regular medicines audits were not consistently identifying when errors occurred. This meant people were not protected from the risks associated with unsafe medicines management.

Prior to this inspection we received information of concern relating to when people, who were cared for in bed, were re- positioned. We found people did not always receive the care which they had been assessed as requiring. Care plans did not always contain accurate information relating to people’s current needs. Changes that had taken place were not always reviewed and recorded in care plans. Risks were identified and assessed. However, care plans did not always direct and inform staff how to reduce specific risks. Staff were not always clear about the care needs of some people.

Prospective new staff were invited to spend ‘taster days’ at the service, supervised by experienced staff, before applying for a position at the service. People attending ‘taster days’ had access to all areas of the service, the people living at the service and their records. One person who had completed such an experience had decided not to take up the position. There were no processes or safeguards in place to ensure these prospective staff would respect people’s right to privacy, dignity and confidentiality once they had done the session and left the service.

Accidents and incidents were not always recorded and reported appropriately. This meant the risk of re-occurrence was not reduced.

We walked around the service which appeared clean and comfortable and bedrooms were personalised to reflect people’s individual tastes. However, there were malodours throughout the service during the inspection. A cupboard marked ‘keep locked’ was found open and contained more than 60 confidential personal care records. Current care files for people living at the service were held in a staff office. The door was open throughout the inspection and was not lockable. This did not protect people’s private information. We found many items lying on the floor in corridors such as a handling belt, a TV, part of a bed rail, a mattress pump, unnamed continence pads, a broken call bell, and foam wedges. This did not protect people moving around the service from potential risk. People were cared for by staff who were kind and patient. However, people did not always have their dignity and privacy respected. Moving and handling equipment and underwear, used to secure continence pads, was shared communally. Toilet doors did not have locks.

Complaints made about the service were not always responded to in line with the Complaints policy.

The service had identified the minimum numbers of staff required to meet people’s needs and these staffing levels were being met. Staff were supported by a system of induction training, supervision and appraisals. More specialised training specific to the needs of people using the service was being provided. Staff meetings were held. These helped communication between staff and management and allowed staff to air any concerns or suggestions they had regarding the running of the service.

The service had a new chef who was in the process of surveying people for their preferences in order to design a new menu. People were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

Activities were planned and provided. There was a cinema which was used weekly. Some people told us they were ‘bored’ at the service. Volunteers visited the service to support the staff with some activities.

The manager was supported by a deputy manager, clinical lead and operations manager.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 you can see the action we have asked the provider to take at the end of the full version of this report.

Inspection carried out on 10 June 2015

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 16 December 2014. We found the service was not meeting the legal requirements. This was because some of the processes to monitor and assess the service provided were not effective. Care plans had not been updated, there was no analysis of learning from monitoring people’s behaviour and people did not have access to meaningful activities.

After the comprehensive inspection the provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches. We undertook a focused inspection on 10 June 2015 to check they had followed their plan and to confirm they now met legal requirements.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Clinton House Nursing Home on our website at www.cqc.org.uk.

Clinton House Nursing Home is a care home that provides nursing and personal care for up to 46 older people. At the time of the inspection there were 36 people living at Clinton House.

The service is required to have a registered manager and at the time of our inspection a registered manager was not in post. However, the manager who was in overall charge was a registered manager at another of the provider’s locations. They were in the process of applying to be the registered manager of this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our focused inspection on 10 June 2015 we found people’s care plans had been updated to accurately reflect how they would like to receive their care and support. This included the analysis of any learning from monitoring people’s behaviour. Staffing numbers had been increased and this meant staff were able to facilitate activities and spend meaningful one-to-one time with people to meet their individual needs. Staff told us, “it is brilliant that staffing levels have been increased, we have time to sit and talk to people”, “our role is to make people happy” and “we have time now to have a laugh with people”.

People were able to take part in a range of activities facilitated by staff in the service. This included an external entertainer, trips out, craft work and card games. People told us, “A group of us play cards with staff”, “I enjoy growing vegetables and plants in the greenhouse”, “I like my daily newspaper it reminds me what is going on in the world” and “I go out on day trips”.

There were systems in place to monitor the quality of the service provided at both the level of the service and with senior management. The auditing process provided opportunities to measure the performance of the service.

Inspection carried out on 16 December 2014

During a routine inspection

Clinton House Nursing Home is a care home that provides nursing care for up to 46 older people. On the day of the inspection there were 32 people living in the home. Some of the people at the time of our visit had mental frailty due to a diagnosis of dementia.

The service is required to have a registered manager and at the time of our inspection a registered manager was not in post. However, the manager who was in overall charge of the day-to-day running of the home had started the process to make an application to the Care Quality Commission (CQC) to become the registered manager. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

We carried out this unannounced inspection of Clinton House Nursing Home on 16 December 2014. At this visit we checked what action the provider had taken in relation to concerns raised at our last inspection on 22 April 2014. At that time we found the provider had not fully implemented an effective system to regularly assess and monitor the quality of service that people received. At this inspection we found the manager had implemented a quality assurance system to identify areas of the service that required improvement. However, we had concerns about the effectiveness of some of the processes to monitor and assess the service provided at the home. This was because some care plans had not been updated, there was no analysis of learning from monitoring people’s behaviour and people did not have sufficient access to meaningful activities. There was no system in place to monitor the quality of the service provided at the provider level by using an auditing process external to the home. You can see what action we told the provider to take at the back of the full version of the report.

On the day of the inspection there was a calm atmosphere in the home and we saw staff interacted with people in a friendly and respectful way. People told us they felt safe living at the home and with the staff who supported them. People told us; “absolutely safe, no verbal or physical abuse”, “very good staff, we can talk to them with any worries but we don’t suffer from worries” and “all staff are approachable”.

Staff had received training in how to recognise and report abuse. They were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.

Staff were well trained; there were good opportunities for on-going training and for them to achieve additional qualifications. There were enough skilled and experienced staff to ensure the safety of people who lived at the home.

We observed the support people received during the lunchtime period. People had a choice of eating their meals in the dining room, their bedroom or one of the lounges. On the day of our inspection there was a delay in serving some people’s lunches. We were advised that there had been a problem in the kitchen and some meals were not ready at the expected time. There was no evidence to suggest that this situation regularly occurred.

People told us about the food provided; “The food here is excellent, you can’t say better than that; we have a choice of two meals mid-day and evening. To stay healthy I get good nutritional food”, “I enjoyed my lunch today”, “I have a choice at mealtimes” and “I’m happy with the food, we get a choice and plenty”.

Staff supported people to be involved in and make decisions about their daily lives. Where people did not have the capacity to make certain decisions the home acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People told us staff treated them with care and compassion. Comments people made included;

“Staff are good with my brother in law, he is treated with dignity”, “I am treated with care and compassion by the staff”, “Staff are very kind” and “all staff are kind to me, full respect every time”. Visitors told us; “home nice and staff seem nice” and “no concerns with the care”.

People received care and support that was responsive to their needs because staff had a good knowledge of the people who lived at Clinton House. Staff were able to tell us detailed information about how people liked to be supported and what was important to them. People’s privacy was respected. Visitors told us they were always made welcome and were able to visit at any time. People were able to see their visitors in communal areas or in private.

People told us they knew how to complain and would be happy to speak with the manager or nurse in charge if they had any concerns. There were systems in place to seek people’s and their families views about the running of the home.

Inspection carried out on 22 April 2014

During a routine inspection

During our inspection of this service we considered our findings to answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. If you want to see the evidence to support our summary please read the full report.

Is the service safe?

People were treated with dignity and respect by staff. We spoke with four people living in the home and they told us they felt safe living there. We found care plans were informative and personalised to the individual, reflected people’s needs and were regularly reviewed.

There were enough staff on duty to meet the needs of the people living at the home. One visitor we spoke with told us they had previously raised concerns about staffing levels, but felt the levels had increased.

Incidents and accidents were recorded and learning from these events was used to change practice to reduce the risk of harm to people.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff understood the signs of abuse and how to raise concerns with the right person when those signs were noticed.

Clinton House had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DOLS). There was evidence the home considered the impact of any restrictions put in place for people that might need to be authorised under the Deprivation of Liberty Safeguards.

Is the service effective?

During our inspection we observed staff caring for people. It was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people’s needs.

People’s health and care needs were assessed and mobility and equipment needs had been identified in where required. Staff we spoke with and observed showed they had good knowledge of the people they supported.

We spoke with two visitors and they confirmed they were able to visit the home whenever they wished and the home kept them informed of any changes to their relative. One visitor told us: “They [the home] keep in touch with us”.

Is the service caring?

People’s individual care plans recorded their choices and preferred routines for assistance with their personal care and daily living. We saw staff provided support in accordance with people’s wishes.

We spoke with four care staff, four people who used the service, two visitors and observed staff interaction throughout our inspection. People we spoke with told us staff were caring and attentive to their needs. People told us: “they [staff] will do anything I want” and “staff are friendly”. We observed staff responding to people in a kind and caring manner.

Is the service responsive?

The home provided some regular group activities such as karaoke, nail and beauty sessions and a visiting hairdresser. The manager told us a new and more individualised activity programme was being developed. Most people we spoke with did not express a view about the activities on offer. One person told us: “there is not enough to do, but there is not a lot I can do now, staff put me where I like to be to watch outside”.

Clinton House gave clear information to people about how to complain. We looked at the home’s complaints policy and saw a copy of the complaints procedure in the entrance hall of the home. Visitors told us they knew how to complain and when they had raised any concerns these had been listened to and acted upon.

Is the service well-led?

The home worked with external health professionals to ensure people’s health needs were met. This included community nurses and GPs.

The provider had not fully implemented an effective system to regularly assess and monitor the quality of service that people received. The provider did not have a system in place to ask people who used the service for their views about their care and treatment.

As a result we were not assured that the quality of the service provided to people was continuingly improving. We have asked the provider to tell us what actions they intend to take to meet the requirements of the law in relation to quality assurance.

Inspection carried out on 26 November 2013

During an inspection to make sure that the improvements required had been made

Clinton House Nursing Home provided care and support to a maximum of 46 people. There were 26 people using the service at the time of our inspection. Nine people required help with personal care and 17 people required nursing care.

Some of the people who lived at Clinton House Nursing Home had a form of dementia and therefore could not always tell us about their experiences. To help us to understand the experiences people had we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allowed us to spend time watching what was happening in a service and helped us to record how people spent their time, the type of support they got and whether they had positive experiences.

We saw people’s privacy and dignity was not always being maintained. People we spoke with told us the staff were “very nice” and; “I find it very nice indeed”. When asked how long they waited for their bell to be answered one person said “they [the staff] will come eventually, depends what they are doing”. We did overhear some staff talking about people’s health and wellbeing in earshot of other people who used the service.

We saw care plans were detailed and generally gave direction as to the care and support people needed. They had been regularly reviewed, but we found some care plans did not reflect the care and support that people currently needed. We saw they were not always developed and reviewed with the person who was using the service and /or their relatives, where appropriate.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

On the day of the inspection there were enough staff to meet people’s needs. We saw staff had the time to maintain a person’s independence, for example, by explaining where the toilet was, when they asked, instead of taking them to it.

People were cared for by staff who were adequately supported to deliver care and treatment safely and to an appropriate standard.

Inspection carried out on 13 August 2013

During a routine inspection

Clinton House Nursing Home provided care and support to a maximum of 46 people. There were 35 people using the service at the time of our inspection.

This was a planned inspection bought forward due to three safeguarding concerns being raised with Adult Care, Health & Well-being (formerly Adult Social Care) since May 2013.The concerns included staff access to the kitchen after 5 pm, small meals, cold meals and drinks for people who were being looked after in their rooms, poor language skills of people whose first language was not English, poor staffing levels and issues around security of the home.

We saw care plans were detailed and gave direction as to the care and support people needed. They had been regularly reviewed.

We saw there was food available to make snacks for people, once the kitchen staff had left at 6 pm. Most people told us they liked the meals they were offered and the portion sizes were adequate for them.

We saw staff were always busy. We were told they were currently only just managing to meet people’s needs. Support systems in place such as one to one meetings were not being used consistently due to lack of time.

Inspection carried out on 24 November 2012

During a routine inspection

We spoke with two people who used the service, and they said they liked it at Clinton House Nursing Home. We saw 21 others in communal areas interacting with the staff, and from the verbal and non-verbal communications seen we understood staff to be attentive, helpful and polite. The atmosphere in the home was warm and welcoming.

Care plans and associated documentation were in place. They were detailed enough to direct and guide staff of the action they needed to take in order to meet people’s assessed care needs. People's records were personalised, and showed choices were made by people in respect of their daily lives.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were protected from unsafe or unsuitable equipment. The home had sufficient and appropriate equipment to meet people's assessed needs.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

Inspection carried out on 14 December 2011

During an inspection in response to concerns

People using the service and their relatives told us they were happy with the care they received at Clinton House.

One person we spoke to said they always knew what activities were ongoing and could join in with what they liked.

We saw staff spending time with people in the communal areas. They were chatting with people, helping people to move about or accessing items for them and serving drinks to them.

People we spoke with told us that the staff are kind and caring and they are well cared for.

One person said you can ‘have a laugh with them’ but they ‘get the job done’.

People told us that they don’t have to wait long if they call for assistance. We were told that the staff were ‘very busy’.

They said that the staff seem to know what to do to help people and ask for help if they are not sure.

People told us that they can approach staff with any questions. They told us that they are asked if everything is ok for them.

Reports under our old system of regulation (including those from before CQC was created)